Dr. Viscusi Exparel is touted to provide up to 72 hours of local anes-
thetic delivery. With a single injection, you get a local anesthetic effect
for an extended period of time, hopefully eliminating the need for a
catheter delivery of local anesthetic. Sometime this year, we hope to
see its indication expanded for use in continuous peripheral nerve
blocks.
Mark Snyder, MD In our independent, prospective, double-blinded, ran-
domized study of 70 knee replacement patients, half of the patients
received Exparel instead of a continuous nerve block. We initiated the
preemption of pain with a spinal anesthetic and injected Exparel into
the posterior capsule before the implant was centered, and also into
the deep capsule, collateral ligaments and deep fascia. We then added
30 cc of 0.5% bupivacaine to the subcutaneous and dermis areas as a
bridge injection because it takes 3 to 4 hours for Exparel to bathe tis-
sue with its bupivacaine effect. Results with Exparel were statistically
better in terms of patient reported pain levels, morphine equivalent
consumption, length of post-op stay, adverse events and fall rate —
patients who received Exparel experienced better results across the
board.
Dr. Viscusi There's still a lot to be determined about Exparel's expand-
ed use. There's no question that pumps and catheters are a burden of
care and an added expense, and there are risks associated with any
kind of indwelling pump and catheter assembly, but you have to look
at these options as a risk-benefit ratio. Continuous catheters provide
fairly targeted local anesthetic administration for the duration of the
time the catheter is placed. The beauty of Exparel is that it's easier to
administer a single injection than it is to place a catheter. But we have
to see if Exparel stands up to what a catheter delivery system pro-
vides. Is it more reliable to do a single injection? Yes, but we don't yet
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | February 2015
